Mixed Bag for Friday, June 5th, 2026

Contributed by HOSPITAL PEREIRA ROSSELL, MONTEVIDEO, URUGUAY
Mariana Otormin, MD, R. Sanzana Cuche, MD, and M. Contreras, MD.

History

F. 14 yo. Lose weight 10 kg / low intake→ Eating disorder. Anemia → Mild dysmenorrea without acute uterine bleeding and bloody stools.

Images (Click any image to enlarge)

ABDOMINAL US: thickening of the terminal ileum
MRI Enteroclysis: discontinuous bowel wall thickening.
CHEST X-RAY
CHEST CT SCAN
CHEST CT SCAN
T1+ Gadolinium.

Question

WHAT IS THE MOST LIKELY DIAGNOSIS?

Your answer

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Correct answer

TUBERCULOSIS WITH EXTRAPULMONARY INVOLVEMENT

Discussion

Extrapulmonary tuberculosis is a multisystemic form of tuberculosis presenting with granulomatous lesions as a result of lymphohematogenous dissemination; it can be of pulmonary or extrapulmonary origin. Common sites of involvement include the hilar lymph nodes, spleen, liver, meninges, vertebrae, joints, and gastrointestinal tract.
This form of tuberculosis is common and represents 15% of cases worldwide and up to 40% in some series. In this case, although suggestive images were presented, the definitive diagnosis was made with a positive PCR for mycobacterium in the bronchoalveolar lavage and in the colonoscopy

Differential diagnosis

  • Cancer (lymphoma, metastases)

  • Autoinmune diseases (sarcoidosis, Crohn’s disease)

  • Fungal infections (blastomycosis)

  • Other chronic infections such as brucellosis, non-tuberculous mycobacteria, HIV associated opportunistic infections, etc

References

  • -Niederbacher Velásquez J, Pulmonologist P, Niederbacher J.Extrapulmonary tuberculosis in children. Neumol Pediatr 2015; 10 (4): 160- 168. -Kritsaneepaiboon S, Andres MM, Tatco VR, Lim CCQ, Concepcion NDP. Extrapulmonary involvement in pediatric tuberculosis. Pediatr Radiol. 2017 Sept;47(10):1249–59. -Dawani A, Gupta AK, Jana M. Imaging in pediatric extra-pulmonary tuberculosis. Indian J Pediatr. 2019 May;86(5):459–67. -Moreno Pérez D, Jesús F, Martín í G, Cañete MC, Jurado A. Update on extrapulmonary tuberculosis. Pediatric Infectious Diseases and Immunodeficiencies Unit. Carlos Haya Maternal and Child Hospital, Málaga.